Masakazu Hanamitsu

Clinical Outcome of Laryngotracheal Separation for Intractable Aspiration Pneumonia

Objectives: To confirm that laryngotracheal separation (LTS) is a satisfactory treatment for patients with intractable aspiration pneumonia, even though it does not require tracheoesophageal anastomosis. Study Design: Retrospective. Methods: Nine patients with intractable aspiration pneumonia underwent LTS at our institution from 1996 to 1999. Two patients underwent postoperative barium swallow radiography. Results: Neither halitosis nor stimulation of the cough reflex occurred due to pooled secretions in the blind pouch of the proximal tracheal segment. Barium swallow radiography confirmed that the secretions drained within 40 min by swallowing or a change in patient position. Conclusion: LTS is a satisfactory solution to the problem of chronic aspiration. Neither pooled secretions in the proximal tracheal segment nor fistula formation were significant postoperative problems.

Detection of Viral DNA in the Endolymphatic Sac in Ménière’s Disease by in situ Hybridization

The main purpose of this study is to search for a viral etiology in Ménière’s disease by examining the presence or absence of herpes family virus DNA in the endolymphatic sac (ES) using the in situ hybridization method. This was a prospective study with the ES from 10 patients with Ménière’s disease and from 7 control cases without any pre-mortem ear diseases except a case of acoustic tumor. These 10 patients underwent the ES surgery. The presence of herpes family virus DNA, such as herpes simplex virus types 1 and 2 (HSV1&2), varicella-zoster virus (VZV), Epstein-Barr virus (EBV) and human cytomegalovirus (CMV), was examined using the in situ hybridization method. Serum antibody titers against these viruses just before the ES surgery were studied in these patients. Of the 10 specimens from the patients with Ménière’s disease, 7 were positive for VZV, 4 for EBV, 1 for CMV and none for HSV1&2, although the serum antibody titers against these viruses did not show any significant elevation in these patients just before the ES surgery. This result suggests that the viral DNA in the ES is inactive and is present in a latent form. From the statistical analysis, it can be postulated that VZV infection in early childhood may reach the ES and play a role in the pathogenesis of Ménière’s disease (p = 0.0235). The double infection with both VZV and EBV tended to be another candidate for the pathogenesis of Ménière’s disease (p = 0.0557).

Cavernous haemangioma of the internal auditory canal: A case report

We report a patient with a cavernous haemangioma of the internal auditory canal (IAC). A 47-year-old man presented with a left profound hearing loss and a left facial palsy that had progressed over 5 years. With a preoperative diagnosis of acoustic or facial nerve neurinoma, the tumour was removed totally by a translabyrinthine approach. Intraoperatively, the tumour appeared red; it compressed the facial and cochlear nerves, and adhered to the vestibular nerve. The tumour was diagnosed as a cavernous haemangioma upon histologic and immunohistochemical examination. No recurrence of tumour occurred, but hearing loss and left facial palsy persisted. Although cavernous haemangiomas of the IAC is found in small size less than 10 mm, they often cause severe hearing loss and facial palsy. Our patient had no improvement of facial palsy, but many reports describe recovery of facial nerve function.

Comparative Study of Vocal Function After Near‐Total Laryngectomy

Objectives: To assess vocal function after near‐total laryngectomy (NTL) and to compare that with after vertical hemilaryngectomy (VHL), both of which use the laryngeal mucosa as the vibratory tissue.

Effect of nitric oxide synthase inhibitor on increase in nasal mucosal blood flow induced by sensory and parasympathetic nerve stimulation in rats.

Objectives Neural control of nasal blood flow (NBF) has not been systematically investigated. The aim of the present study was to evaluate the effect of electrical stimulation of both sensory and parasympathetic nerves innervating the nasal mucosal arteries on NBF in rats. Methods In anesthetized rats, nasociliary (sensory) nerves and postganglionic (parasympathetic) nerves derived from the right sphenopalatine ganglion were electrically stimulated. We measured NBF with a laser-Doppler flowmeter. Results The nerve stimulation increased NBF on both sides and increased the mean arterial blood pressure. The increase in NBF was larger on the ipsilateral side than on the contralateral side. Hexamethonium bromide, a ganglion blocker, abolished the stimulation-induced pressure effect and the increase in NBF on the contralateral side, but did not abolish the increase in NBF on the ipsilateral side. The remaining increase in NBF was abolished by NG-nitro-L-arginine, a nitric oxide synthase inhibitor. Histochemical analysis with nicotinamide adenine dinucleotide phosphate-diaphorase showed neuronal nitric oxide synthase-containing nerves that innervate nasal mucosal arteries. Conclusions Nitric oxide released from parasympathetic nitrergic nerves may contribute to an increase in NBF in rats. The afferent impulses induced by sensory nerve stimulation may lead to an increase in mean arterial blood pressure that is partly responsible for the increase in NBF.

Autoantibodies against inner ear proteins in patients with delayed endolymphatic hydrops and unilateral juvenile deafness.

Conclusions. Patients with the contralateral type of delayed endolymphatic hydrops (DEH) may undergo an autoimmune attack against the other inner ear. As patients with unilateral juvenile deafness show no progression, despite lengthy observation, the autoantibody against the 68-kDa protein may be unrelated to the pathogenesis of DEH. Objective. The contralateral type of DEH is believed to have an autoimmune etiology, and sometimes develops from unilateral juvenile deafness. The purpose of this study was to determine whether autoantibodies are pathogenetically important in DEH. Material and methods. Sera from 9 patients with DEH, 18 patients with profound unilateral juvenile hearing loss and 15 control volunteer without inner ear diseases were investigated by means of Western blot assay against rat inner ear proteins. Results. Among 8 patients with the contralateral type of DEH, 6 (75%) showed at least 1 reactive band on Western blotting. The protein that reacted most frequently had a molecular weight of 28 kDa, which was consistent with our previous results. Among 18 patients with unilateral juvenile deafness, 5 (28%) showed reactive bands, exclusively at 68 kDa.

A Case of Earpick Injury with Delayed Facial Paralysis

We reported a rare case of ear trauma with delayed facial paralysis, ossicular chain dislocation and perilymph fistula caused by an earpick. A 36-year-old male consulted our clinic with a complaint of left otalgia, hearing loss, tinnitus and dizziness after left ear trauma with an earpick. Otoscopic examination showed perforation of the left ear-drum and pure tone audiometory demonstrated a mixed hearing loss with an average air conduction threshold of 53dB on the initial examination. He was diagnosed as having a traumatic ear-drum perforation. Left facial paralysis occurred 6 days after the trauma, then recovered after the intravenous steroid treatment. Hearing impairment did not improve after spontaneous closure of the ear-drum perforation, and exploratory tympanoplasty was performed. At surgery, the incus was dislocated and the anterior and posterior crura of stapes were fractured. Perilymphatic leakage from the fractured footplate was noted. The footplate was covered with temporal fascia and ossicular chain reconstruction was performed using the incus on the foot plate as a columella. Post operationally, the hearing threshold improved with an average air conduction threshold of 31.7dB.

A Case of Inflammatory Pseudotumor of the Orbit

An inflammatory pseudotumor is one of the major neoplasm arising in the orbit. We reported a case of inflammatory pseudotumor of the orbit that was successfully treated. A 73-old-male was referred to our department with a complaint of swelling of the left eye lid. CT findings showed a tumor of the left orbit extending into the ethmoid sinus. Incisional biopsy was performed through the left maxillary sinus. Histologic examination demonstrated a non-specific inflammatory lesion with fibrous tissues and inflammatory cells. The pathologic diagnosis was benign pseudotumor. The patient was given steroid therapy (for 5 weeks) and radiotherapy (2 Gy•~10 days) which resulted in complete response at discharge. Steroid therapy was continued for 6 months after discharge. There has not been any recurrence of the tumor during more than 2 years follow up. Clinical manifestations, histopathologic findings and treatment of this lesion are discussed.

Auditory cortical response to monaural stimulation detected by functional magnetic resonance imaging

Abstract Few reports have characterized auditory processing in monaural listening, which is important for the understanding of auditory brain activity in subjects with hearing loss. We measure regional brain activity in response to monaural audition of 95 dB sound pressure level (SPL) monosyllables using functional magnetic resonance imaging (fMRI) in the 10 subjects with normal hearing and four subjects with unilateral deafness as controls for “cross-hearing”. Images were analyzed by statistical parametric mapping software. In subjects without hearing loss, the stimuli elicited cortical activation in the primary auditory and auditory association regions, particularly contralaterally where extent of activation was approximately 2.5 times the ipsilateral extent. All patients with profound unilateral deafness showed no statistically apparent response in the primary auditory and auditory association regions, ruling out an important influence from cross-hearing. We found fMRI to be a useful technique for analysis of auditory processing that should be applicable to patients with various hearing abnormalities.

Lack of Reported Mutations in a Japanese Case of Toxic Multinodular Goiter

We describe a toxic multinodular goiter that was subjected to genomic sequencing of the thyroid-stimulating hormone receptor and the α-subunit of the stimulatory guanine nucleotide-binding protein. No mutation was detected in either gene. While frequent occurrence of thyroid-stimulating hormone receptor gene mutations in toxic multinodular goiters has been reported in areas such as part of Europe with a relatively high prevalence of iodine deficiency, toxic multinodular goiters in areas with an abundance of dietary iodine such as Japan seem unlikely to involve mutations of this gene.